Objectives/Hypothesis The objective of this project was to develop a virtual temporal bone dissection system that would provide an enhanced educational experience for the training of otologic surgeons. Study Design A randomized, controlled, multi-institutional single blinded validation study. Methods The project encompassed 4 areas of emphasis: structural data acquisition, integration of the system, dissemination of the system, and validation. Results Structural acquisition was performed on multiple imaging platforms. Integration achieved a cost effective system. Dissemination was achieved on different levels including casual interest, downloading of software, and full involvement in development and validation studies. A validation study was performed at 8 different training institutions across the country using a two arm, randomized trial where study subjects were randomized to a two-week practice session using either the virtual temporal bone or standard cadaveric temporal bones. Eighty subjects were enrolled and randomized to one of the two treatment arms, 65 completed the study. There was no difference between the two groups using a blinded rating tool to assess performance after training. Conclusions 1. A virtual temporal bone dissection system has been developed and compared to cadaveric temporal bones for practice using a multi-center trial. 2. There is no statistical difference seen between practice on the current simulator when compared to practice on human cadaveric temporal bones. 3. Further refinements in structural acquisition and interface design have been identified which can be implemented prior to full incorporation into training programs and use for objective skills assessment.

The system provides an environment to learn temporal bone surgery in a way similar to the experience with cadaver material where the subject is able to interact with the data without constraints (nondeterministic). Eventually, it may provide the "front end" to a large repository of various temporal bone pathologies that can be accessed through the Internet.

The number of personnel providing in-home health care services is increasing substantially. The unique configuration of environmental hazards in individual client homes has a significant impact on the safety and health of home health care providers (HHPs). This mixed-methods study used data from a standardized questionnaire, focus groups, and individual interviews to explore environmental health and safety hazards encountered by HHPs in client homes. The participant sample (N = 68) included nurses, aides, therapists, and owners/managers from a variety of geographic locations. The most often-reported hazards were trip/slip/lift hazards, biohazards, and hazards from poor air quality, allergens, pests and rodents, and fire and burns. Frequency of identified key hazards varied by room, that is, kitchen (e.g., throw rugs, water on floor), bathroom (e.g., tight spaces for client handling), bedroom (e.g., bed too low), living room (e.g., animal waste), and hallway (e.g., clutter). Findings indicate the need for broader training to enable HHPs to identify and address hazards they encounter in client homes.

Objectives/Hypothesis There is increasing interest in objective assessment of surgeon competence. In the field of otolaryngology, several surgical training programs, including The Ohio State University, the University of Toronto, and Stanford University, have pursued standardized criteria to rate their trainees’ performance in the initial steps of temporal bone dissection (complete mastoidectomy with facial recess approach). Although these assessment metrics require the completion of similar basic components integral to successful temporal bone dissection, certain listed criteria are unique to each institution. Our aim was to establish a more standardized set of criteria that can be used across different institutions to objectively assess temporal bone dissection. We translated these new criteria into automated metrics in our temporal bone dissection simulator to achieve even more objective grading of temporal bone dissections. Study Design Cross-sectional study/survey. Methods The temporal bone assessment criteria developed by each of the three aforementioned institutions were compiled into an all-encompassing scale. This compilation was sent out as an online survey to members of the American Neurotology Society and American Otological Society with instructions to rate the importance of each criterion. Results Criteria that were ranked by >70% of respondents as either “very important” or “important” were used to create the new, cross-institutional scale for the objective assessment of temporal bone dissection. Conclusions The new assessment scale and its eventual incorporation into the temporal bone surgical simulator will enhance the objectivity of currently existing methods to evaluate surgical performance across different institutions.

Purpose To develop a time-efficient automated segmentation approach that could identify critical structures in the temporal bone for visual enhancement and use in surgical simulation software. Methods An atlas-based segmentation approach was developed to segment the cochlea, ossicles, semicircular canals (SCCs), and facial nerve in normal temporal bone CT images. This approach was tested in images of 26 cadaver bones (13 left, 13 right). The results of the automated segmentation were compared to manual segmentation visually and using DICE metric, average Hausdorff distance, and volume similarity. Results The DICE metrics were greater than 0.8 for the cochlea, malleus, incus, and the SCCs combined. It was slightly lower for the facial nerve. The average Hausdorff distance was less than one voxel for all structures, and the volume similarity was 0.86 or greater for all structures except the stapes. Conclusions The atlas-based approach with rigid body registration of the otic capsule was successful in segmenting critical structures of temporal bone anatomy for use in surgical simulation software.

This article focuses on key issues surrounding the needs and application of simulation technologies for technical skills training in otolaryngology. The discussion includes an overview of key topics in training and learning, the application of these issues in simulation environments, and the subsequent applications of these simulation environments to the field of otolaryngology. Examples of past applications are presented, with discussion of how the interplay of cultural changes in surgical training in general, along with the rapid advancements in technology have shaped and influenced their adoption and adaptation. The authors conclude with emerging trends and potential influences advanced simulation and training will have on technical skills training in otolaryngology.

Purpose Automatic scoring of resident performance on a virtual mastoidectomy simulation system is needed to achieve consistent and efficient evaluations. By not requiring immediate expert intervention, the system provides a completely objective assessment of performance as well as a self-driven user assessment mechanism. Methods An iconic temporal bone with surgically important regions defined into a fully partitioned segmented dataset was created. Comparisons between expert-drilled bones and student-drilled bones were computed based on gradations with both Euclidean and Earth Mover’s Distance. Using the features derived from these comparisons, a decision tree was constructed. This decision tree was used to determine scores of resident surgical performance. The algorithm was applied on multiple expert comparison bones and the scores averaged to provide reliability metric. Results The reliability metrics for the multi-grade scoring system are better in some cases than previously reported binary classification metrics. The two scoring methods given provide a trade-off between accuracy and speed. Conclusions Comparison of virtually drilled bones with expert examples on a voxel level provides sufficient information to score them and provide several specific quality metrics. By merging scores from different expert examples, two related metrics were developed; one is slightly faster and less accurate, while a second is more accurate but takes more processing time.

The FESS simulator uses both visual and haptic feedback to create a virtual reality environment to teach paranasal sinus anatomy and basic endoscopic sinus surgery techniques to ear, nose, and throat residents. The results of the current study showed that the haptic device was accurate in and of itself, within its current physical limitations, and that the isosurface-based simulator was preferred.